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MS: Treating earliest signs reduces risk of diagnosis, relapse

Treating the earliest signs of multiple sclerosis - such as numbness and balance or vision problems - with the drug interferon beta-1b may reduce the risk of a definitive diagnosis of the condition, as well as reduce relapse following a diagnosis. These are the findings of new research published in the journal Neurology.

Researchers say using the drug interferon beta-1b to treat the earliest signs of MS could offer long-term benefits.

Early symptoms of MS include numbness or tingling of the face, body, or arms and legs, fatigue, loss of balance, dizziness, and vision problems.

There is currently no cure for MS, but there are treatments that can help patients manage their symptoms. Interferon beta-1b is one such treatment; the drug is used to reduce symptoms in patients with relapsing-remitting MS (RRMS), whereby attacks of symptoms arise, before improving or disappearing.

However, study co-author Dr. Ludwig Kappos, of University Hospital Basel in Switzerland, and colleagues note that there has been little investigation into how starting this treatment at the earliest stages of MS might affect disease progression.

To find out, the team enrolled 468 individuals who were showing early signs of MS, but who had not yet been diagnosed with the condition.

Subjects were randomly assigned to one of two groups; one group received early treatment with interferon beta-1b, while the other received a placebo.

After 2 years or a diagnosis of MS - whichever came first - subjects who had been taking the placebo were allowed to switch to interferon beta-1b or another MS drug.

Likelihood of MS diagnosis 33 percent lower with early treatment

Eleven years after study initiation, 278 participants remained, of whom 167 had received early treatment with interferon beta-1b and 111 had received delayed treatment with the drug.

Compared with subjects who had delayed interferon beta-1b treatment, those who had received early treatment with the drug were 33 percent less likely to have been diagnosed with MS.

The team also found that participants who had received early treatment with interferon beta-1b took longer to have their first MS relapse than those whose treatment was delayed, at 1,888 days versus 931 days.

Additionally, the annual relapse rate was 19 percent lower for participants who received early treatment, compared with those who had delayed treatment, with an annual relapse rate of 0.21 and 0.26, respectively.

Dr. Kappos told Medical News Today that the team was surprised by these results. "The most astonishing observation was that relapse rates remained lower in most of the years after both groups had equal access to treatment," he noted.

No differences were found between the early and delayed treatment groups for overall disability or the amount of CNS damage caused by MS.

Based on these study results, Dr. Kappos told MNT that patients in the early stages of MS may see long-term benefits with the use of interferon beta-1b.

"It was reassuring to see that little progression occurred in both treatment groups over these 11 years. For me this underlines that - although the options are better with a very early intervention - the window of opportunity remains open for some time."

Dr. Ludwig Kappos

The researchers say their study - which was funded by Bayer HealthCare Pharmaceuticals - does have some limitations.

For example, they note that both the patients and researchers learned which subjects were taking interferon beta-1b or placebo after fifth-year tests. Additionally, they note that all participants were receiving treatment after the first 2 years, meaning there was no longer an untreated control group.

Dr. Kappos told us that he and his team now plan to assess whether other compounds that work in a similar way to interferon beta-1b, but which are more effective, may be beneficial if given to patients in the earliest stages of MS.

"A burning but not easy-to-resolve question is if these results that were achieved with Interferon beta 1b - a 'first-generation' compound - would be further improved by treating as early with one of the more recently developed treatments that have shown more efficacy in established relapsing MS," he said. "Similarly we need to improve on our ability to predict who are the best candidates for this treatment."

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